1. Infection in Oral & Maxillofacial Region
Pandect
Yu Chuang-Qi

2. Infection--- in oral & maxillofacial region
Pandect
Infection--- in oral & maxillofacial region
Infection Conception
Trait Anatomy
Arising Route
Mutation Influence factors
Diagnosis Principles
Treatment Principles

3. Infection---conception
Infectious agent(bacteria)
Host
Inflammatory reaction
protective and defensive
Beneficial
Elimination the infectious pathogen
Repair tissue injury
Harmful
Hypersensitivity Autoimmune disease

4. Trait of anatomy Oral and nasal cavity Tooth Space
Blood and Lymphoid system
Bacteria

5. Trait of anatomy Bacteria---Exist Oral and nasal cavity
Maxillary sinus(上颌窦)
Temperature + Moisture
(Beneficial)
Reproduction + Developing

6. Trait of anatomy Tooth Caries Alveolar bone Pulpitis Soft tissue
Apical infection
Alveolar bone
Soft tissue
Fascial space

7. Trait of anatomy Fascial space(间隙)---loose connective tissue
Among skin, maxillary and muscle
Purulent--- spreading way
Do not exist in healthy state
Become filling during infection

8. Cavernous sinus thrombosis
Trait of anatomy
Blood and lymphoid system
Beneficial
Abundance
Harmful
Encephalic infection
Dangerous triangle
Lacking valves
Cavernous sinus
Cavernous sinus thrombosis

9. Trait of pathogenic bacterium
Flora(菌丛)
Varied
Numerous
Streptococcus hemolyticus
(溶血性链球菌)
Staphylococcus aureus
(金黄色葡萄球菌)
Escherichia coli
(大肠杆菌)
Anaerobe
(厌氧菌)
Sterile
Simple
Complex

10. Route of infection Odontogenic infection Adenogenous(腺源性) infection
Traumatic infection
Hematogenous(血源性) infection
Iatrogenic(医源性) infection

11. Odontogenic infection
Periapical infection
Pericoronitis(冠周炎)

12. Periapical infection Acute-chronic Periapical infection Fistular(瘘)
Cellulitis
(蜂窝织炎)
Intraoral soft tissue abscess
(脓肿)
Osteomyelitis
(骨髓炎)
Septicemia(败血症)
Deep fascial space infection
Ascending facial-cerebral infection

13. Pathways of Periapical infection

14. Pericoronitis (冠周炎)
Lower third molar

15. Infection---Arising Host--- defense system
Microbe---virulence quantity
Local circumstance
Balance Imbalance
Scale

16. Mutation
Influence factors
Changing directions

17. Influence factors Host--- defense system Microbe---virulence quantity
Treatment strategy

18. Changing directions Localization and recovery Acute chronic Diffusion
Blood system---Septicemia
lymphoid system---Lymphadenopathy
From submandible space infection to chest region

19. How to diagnose? Local Signs and Symptoms
Systemical Signs and Symptoms

20. Local Signs and Symptoms
Locally
Pain
Swelling
Surface erythema
Pus formation
Limitation of motion

21. Systemical Signs and Symptoms
Fever
Lymphadenopathy
Malaise
Toxic appearance
Elevated white blood cell count

22. How to treat?
Acute stage
Chronic stage

23. Acute stage
Host
Antibiotic therapy
Surgical drainage and incision

24. Host Defense Mechanisms Critical Principles
Migration of white blood cell
Production of antibodies
Critical Principles
Most important factor --- final outcome
The infections--- cured by the host, not by antibiotics

25. Principles for choosing appropriate antibiotic
Antibiotic era
causative organism(致病菌)
sensitivity
specific, narrow-spectrum antibiotic
least toxic antibiotic
drug history(success, allergic and toxic)

26. Principles of antibiotic administration
Proper dose
Proper time interval
Proper route of administration(oral, parenteral)
Combination antibiotic therapy

27. Surgical drainage and incision
How to judge the pus formation?
Purposes of surgical drainage and incision
Principles of surgical drainage and incision

28. How to judge the pus formation?
Characteristic
Duration--- >5 days
Palpation---Fluctuant
Appearance---Reddened
Needle aspiration
B-ultrasound CT
Three stages
Inoculation
Cellulitis
Abscess

29. Fluctuant examination

30. Purposes of surgical drainage & incision
Rid the body of toxic purulent material
Decompress the tissues
Allowing better perfusion of blood containing antibiotics and defensive elements
Increased oxygenation of the infected area

31. Infection in masseteric space

32. Infection in multi-space
Ludwig’s angina

33. Principles of surgical drainage & incision
Place the incision in an esthetically acceptable
Place the incision in a dependent position to encourage drainage by gravity
Dissect bluntly through deeper tissues and explore all portions of the abscess
Place a drain and stabilize it with sutures

34. Principles of surgical drainage & incision

35. Chronic stage Surgical removal of the focus(病灶)
Lesion tooth---Impacted tooth
Osteomyelitis

36. Infection in oral & maxillo-facial region
Conclusion
Infection in oral & maxillo-facial region
The trait of Infection
Odontogenic infection
mutation of infectious
Diagnosis of the infection
Diagnosis of the abscess formation
The principles of the treatment

37. Thank you